UnitedHealthcare hopes to address social factors leading to poor health
PHILADELPHIA — Purvis Wright’s health, and life, were spiraling out of control.
Mr. Wright went to the hospital in July 2018 after a spate of blackouts and throwing up blood.
“It was all downhill,” Mr. Wright said this month. “I wound up with my eight or nine different sicknesses all at once.”
After a long stay at Einstein Medical Center Philadelphia, Mr. Wright tried going home that September, but the West Oak Lane house where he had an apartment had been sold and all his belongings were gone. That setback forced Mr. Wright, 62, onto an odyssey of depending on siblings and homeless shelters for a roof and a bed.
Things started looking up in November, when Cynthia Brown, a community health worker with Mr. Wright’s Medicaid plan, plucked Mr. Wright out of the chaos and steered him toward a new housing program from UnitedHealthcare that the world’s largest health insurer was starting in Philadelphia for some of its homeless, chronically ill members.
That program, now in a dozen states, is part of a growing effort over the past decade to help patients struggling with homelessness, poverty and violence, factors that have been recognized as powerful forces causing, or exacerbating, poor health.
“Many of the people we serve,” said Allison Davenport, chief executive of the Medicaid plan, UnitedHealthcare Community Plan of Pennsylvania, have “experienced such instability that their health care becomes intractable. It compounds, it compounds, it compounds and they can’t address that in a completely unstable situation.”
In Philadelphia, about 400,000 people live in poverty, a steppingstone to chronically poor health and one that makes the city ripe for such interventions as the one UnitedHealth has brought here. For insurers, it is a matter of money, too, when poor health forces such patients to visit emergency rooms more frequently, costing tens of thousands of dollars.
Since 2016, Pennsylvania’s
Department of Human Services has announced at least $8.8 million in grants to nonprofits to address social factors that make it hard for the 320,000 Medicaid beneficiaries in North Philadelphia to stay healthy. No rigorous system for evaluating those efforts has been established.
A lot is riding on such experiments as the one by UnitedHealth because the sickest 1% of the population accounted for 22% of $3.3 trillion in national health care spending in 2016, according to a federal estimate.
UnitedHealth’s housing program, called myConnections, was founded by Jeffrey Brenner.
This is not the first time Dr. Brenner, who worked as a family physician in Camden, N.J., for years starting in 2000, is attempting to tackle such intractable issues as homelessness that contribute to poor health and high costs.
Dr. Brenner gained national renown in the early 2010s for his work at the Camden Coalition of Healthcare Providers, a pioneer in the use of data to track complex patients. A 2011 New Yorker article described their work as “revolutionary” in its ability to trim the cost of health care for “super-utilizers.”
Before leaving Camden for UnitedHealthcare in 2017, Dr. Brenner invited researchers from Massachusetts Institute of Technology to study the effectiveness of the coalition’s program, which focused on coordinating care, helping patients with complex conditions navigate health care services and helping them connect to social services.
The study, published last month, brought disappointing news. It found that patients — with at least two chronic conditions — adopted by the Camden Coalition went back to the hospital just as often as patients in a control group who received no special treatment after a hospital discharge.
Given Dr. Brenner’s prominence, the results received national attention. Still, declaring that these patients are just too hard to help without first solving poverty and other deep-rooted social ills would be precisely the wrong conclusion, said Shreya Kangovi, a professor at the University of Pennsylvania’s Perelman School of Medicine.